Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica

Abstract

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

Machine learning to predict cardiovascular risk

“…To assess the quality of the classification, we used a 5% risk cutoff (indicating high cardiovascular risk) for SCORE and for all the ML methods, and a 10% cutoff for REGICOR . Applying this cutoff on the testing sample, we calculated the diagnostic accuracy rate, the error rate, sensitivity and specificity with 95% CIs, positive and negative predictive values, the positive likelihood ratio with 95% CI, and the number needed to treat to prevent a harmful outcome.…”

“…In some regions of Spain, the REGICOR risk score—a local adaptation of the Framingham scale—is used. Clinicians are advised to assess risk at 5‐year intervals in patients with at least one important risk factor, such as exposure to tobacco, diabetes, hypertension, or dyslipidaemia . However, SCORE overestimates 10‐year cardiovascular mortality in the Spanish population, resulting in false positives that lead to unnecessary treatment as well as false negatives that fail to reflect individuals’ real risk .…”

Cerebral Small Vessel Disease Associated with Subclinical Vascular Damage Indicators in Asymptomatic Hypertensive Patients

“…Therefore, early detection of subclinical brain damage is essential to reduce risks and prevent irreversible sequelae. Together with the heart, blood vessels, retina, and kidney, the identification of clinical or subclinical brain damage as a target organ is included within the stratification of cardiovascular risk, according to the European HT guidelines [12,13,14]. Since the brain is one of the most affected target organs in hypertension [15,16,17], early damage in the cerebral microcirculation leading to a microangiopathy—Called cerebral small vessel disease (CSVD)—is present [18,19].…”

Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española

“…Las funciones de riesgo seleccionadas fueron aquellas recomendadas para España 19 validadas y cuyo rendimiento había sido comprobado anteriormente en nuestra cohorte 14 . Para cardiopatía isquémica: Framingham calibrada por REGICOR 23 y FRESCO para esta enfermedad, en su versión larga (FRESCO CI) 24 .…”

“…El presente trabajo se ha desarrollado en una comunidad que presenta una incidencia de morbimortalidad cardiovascular más elevada que la media nacional desde hace décadas 18 , desconociendo si el ITB pudiera proporcionar información complementaria como marcador de riesgo de otras formas clínicas de enfermedad cadiovascular (ECV), distintas de la cardiopatía isquémica, sobre las que hay resultados contradictorios o para mejorar la capacidad predictiva de otras funciones de riesgo propuestas para España, como FRESCO y SCORE 19 , que abordan la predicción de las ECV de forma más global.…”